Immune system

Question 1

Methotrexate

Answer 1

MoA - Inhibition of dihydrofolate reductase and DNA synthesis for lymphocyte proliferation

Indications - RA

Adverse effects - nausea, hair loss

Interactions - Warfarin, corticosteroids

Question 2

Azathioprine

Answer 2

MoA - unclear - possible inhibition of DNA synthesis and lymphocyte proliferation

Indications - RA (also Crohn’s disease)

Adverse effects - alopecia

Question 3

Adalimumab, etanercept, infliximab

Answer 3

TNF-alpha blockade

Indications - RA

Adverse effects - Infections

Question 4

Aminosalicylates

Answer 4

Sulfasalazine, mesalazine

MoA - unclear - possible COX inhibition. Possible free radical scavenging, T cell suppression

Indication - RA (also Crohn’s disease)

Adverse effects - Nausea

Interactions - digoxin, warfarin

Question 5

Anti-histamines

Answer 5

Chlorphenamine, cetirizine

MoA - H1 histamine receptor blockade

Indications - hay fever, urticaria

Adverse effects - dry mouth, sedation

Interactions - TCA

Question 6

Prednisolone, hydrocortisone, dexamethasone

Answer 6

Glucocorticoids

MoA - Intracellular transcription factor interactions, gene expression

Indications - Suppression of inflammatory diseases (eg. Crohn’s, RA)

Adverse effects - weight gain, muscle atrophy

Interactions - oral anti diabetics

Question 7

Calcineurin inhibitor

Answer 7

cyclosporin, tacrolimus

MoA - Inhibition of T cell signalling

Indications - Solid organ transplantation, eczema (topical)

Adverse effects - hypertension

Interactions - aspirin